MEDICARE: INDIAN RIVER HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME103803	FL

General Provider Information

NPI Number	:	1376850560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIAN RIVER HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	1000 36TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4862
Country	:	US
Telephone Number	:	772-567-4311
Fax Number	:	772-794-1450

Provider Business Practice Location Address
First Line	:	1960 POINTE WEST DR
Second Line	:	SUITE 102
City	:	VERO BEACH
State	:	FL
Zip	:	32966-1302
Country	:	US
Telephone Number	:	772-567-4311
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	JEFFREY L SUSI
Credential	:
Telephone Number	:	772-567-4311

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	09/09/2010

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Directions to “INDIAN RIVER HEALTH SERVICES INC ” Practice Location

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